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1.
Journal of Clinical Hepatology ; (12): 965-968, 2022.
Article in Chinese | WPRIM | ID: wpr-923319

ABSTRACT

The tumor microenvironment of pancreatic carcinoma is a dense matrix environment with excessive fibrosis containing pancreatic stellate cells, cancer-associated fibroblasts, immune cells, and extracellular matrix, which not only creates an environment to promote the growth and invasion of tumors, but also makes them resistant to chemotherapy and other antitumor drugs. Intensive fibrosis reaction in the matrix and changes of tumors in immune environment are considered the main reasons for treatment failure in pancreatic cancer management. This article reviews the recent research advances in the tumor microenvironment of pancreatic cancer, summarizes its composition and pathogenesis and the targeted therapies for matrix and immune cells, and analyzes the importance of tumor microenvironment in the development and progression of pancreatic cancer and its impact on targeted therapy.

2.
China Pharmacy ; (12): 96-103, 2022.
Article in Chinese | WPRIM | ID: wpr-907020

ABSTRACT

OBJECTIVE To re-eval uate the systematic review and meta-an alysis of umeclidinium bromide and vilanterol trifenatate(UMEC/VIL)in the treatment of chronic obstructive pulmonary disease (COPD),so as to provide evidence-based basis for the treatment of COPD. METHODS Retrieved from PubMed (Medline),the Cochrane library ,Embase,CNKI,CBM,VIP and Wanfang database ,etc.,the systematic review and meta-analysis of UMEC/VIL in the treatment of COPD were collected from the inception to Apr. 2021. Two reviewers independently screened the literatures and extracted the data. AMSTAR 2 scale,PRISMA statement,and GRADE evaluation system were used to evaluate the methodological quality of the included studies ,the quality of reports and the grade of outcome indexes. The efficacy and safety of UMEC/VIL in the treatment of COPD were reported. RESULTS Six systematic reviews were finally included. The results of AMSTAR 2 scale showed that 1 study was of high quality , 2 were of medium quality and 3 were of low quality. The score of PRISMA statement was between 21.5 and 27,and the quality of the report was relatively perfect. The results of GRADE evaluation showed that more than 60% of the 134 outcome indicators were of medium to high quality of evidence. Comparison of effectiveness and safety showed that UMEC/VIL was superior to placebo , unilateral bronchodilator and salmeterol fluticasone in improving forced expiratory volume in one second (FEV1)trough,FEV1 peak and forced vital capacity (FVC). In the improvement of transition dyspnea index (TDI),SGRQ and SOBDA scores ,UMEC/ VIL was better than placebo ,unilateral bronchodilator and fluticasone propionate/salme terol. The adverse reaction rate ,acute exacerbation rate ,mortality rate ,withdrawal rate ,pneumonia rate and other negative indicators of UMEC/VIL were not inferior to placebo,unilateral bronchodilator and fluticasone propionate/salme terol. CONCLUSIONS Compared with placebo and unilateral bronchodilator,UMEC/VIL can significantly improve lung function ,symptoms and quality of life ,and has non-inferior effect for negative indicators. Compared with β2 adrenoceptor agonists combined with glucocorticoid ,UMEC/VIL can improve lung function of COPD patients ,but they are similar in other aspects.

3.
Article in Chinese | WPRIM | ID: wpr-942356

ABSTRACT

This report presented the endemic status of schistosomiasis and analyzed the data collected from the national schistosomiasis prevention and control system and national schistosomiasis surveillance sites in the People’s Republic of China at a national level in 2021. Among the 12 provinces (municipality and autonomous region) endemic for schistosomiasis in China, Shanghai Municipality, Zhejiang Province, Fujian Province, Guangdong Province and Guangxi Zhuang Autonomous Region continued to consolidate the achievements of schistosomiasis elimination, and Sichuan and Jiangsu provinces maintained the criteria of transmission interruption, while Yunnan, Hubei, Anhui, Jiangxi and Hunan provinces maintained the criteria of transmission control by the end of 2021. A total of 451 counties (cites, districts) were found to be endemic for schistosomiasis in China in 2021, with 27 571 endemic villages covering 73 250 600 people at risk of infections. Among the 451 endemic counties (cities, districts), 75.17% (339/451), 22.17% (100/451) and 2.66% (12/451) achieved the criteria of elimination, transmission interruption and transmission control of schistosomiasis, respectively. By the end of 2021, 29 037 cases with advanced schistosomiasis were documented in China. In 2021, 4 405 056 individuals received serological tests and 72 937 were sero-positive. A total of 220 629 individuals received stool examinations and 3 were positive. In 2021, snail survey was performed in 19 291 endemic villages in China and Oncomelania snails were found in 7 026 villages, accounting for 36.42% of all surveyed villages, with 12 villages identified with emerging snail habitats. Snail survey was performed at an area of 686 574.46 hm2 and 191 159.91 hm2 snail habitats were found, including 1 063.08 hm2 emerging snail habitats and 5 113.87 hm2 reemerging snail habitats. In 2021, 525 878 bovines were raised in the schistosomiasis endemic areas of China, and 115 437 received serological examinations, with 231 positives detected. Among the 128 719 bovines received stool examinations, no positives were identified. In 2021, there were 19 927 schistosomiasis patients receiving praziquantel chemotherapy, and 729 113 person-time individuals and 256 913 herd-time bovines were given expanded chemotherapy. In 2021, snail control with chemicals was performed in 117 372.74 hm2 snail habitats, and the actual area of chemical treatment was 65 640.50 hm2, while environmental improvements were performed in snail habitats covering an area of 1 244.25 hm2. Data from the national schistosomiasis surveillance sites of China showed that the mean prevalence of Schistosoma japonicum infections were both zero in humans and bovines in 2021, and no S. japonicum infection was detected in snails. The results demonstrate that the overall endemic status of schistosomiasis remained at a low level in China in 2021; however, the progress towards schistosomiasis elimination was slowed and the areas of snail habitats rebounded mildly. Strengthening researches on snail diffusion and control, and improving schistosomiasis surveillance and forecast are recommended to prevent reemerging schistosomiasis.

4.
Article in Chinese | WPRIM | ID: wpr-940713

ABSTRACT

The present study explored the effective approaches to realize the leading role of traditional Chinese medicine (TCM) in preventing diseases, the synergistic role in treating serious diseases, the core role in the rehabilitation of diseases and summarized the experience to provide feasible plans for the evaluation of other dominant diseases of TCM. To evaluate the effectiveness, safety, and economy of TCM in the treatment of ischemic stroke, encephalopathy project team of the China Center for Evidence-based Traditional Chinese Medicine(CCEBTCM) established an evaluation group to determine the work plan and complete the evaluation work. The concepts of the evaluation involved high-quality evidence, expert opinion survey, expert interview, and drug catalog. Under the guidance of clinical experts and methodologists, the evaluation work was completed in accordance with four steps, i.e., plan making, data collection and data extraction, evidence synthesis and evaluation, and report writing with the rapid review method. Through the review of TCM and western medicine experts, the advantage of TCM in the treatment of ischemic stroke was positioned in the convalescence period with the predominant effects of improving the neurological function defect and improving the daily living ability. In the convalescence period of stroke, TCM treatment could improve post-stroke motor dysfunction, post-stroke cognitive impairment, consciousness disorder, swallowing disorder, aphasia, constipation, urinary function, diplopia, etc., and the advantages of acupuncture, Chinese medicine, and traditional exercise were more prominent. In terms of safety, TCM treatment of ischemic stroke showed lower incidence of adverse reactions, fewer adverse events, and a milder degree of related symptoms. In terms of economic performance, the combined treatment of TCM and western medicine played a synergistic role and made the treatment cost more reasonable. Compared with conventional intervention, the integrated TCM and western medicine rehabilitation program showed more economic and social benefits.

5.
Article in Chinese | WPRIM | ID: wpr-940536

ABSTRACT

Evidence and value:impact on DEcisionMaking (EVIDEM) framework was developed by EVIDEM collaboration. Its core is the combination of multiple criteria decision analysis (MCDA) model and standardized health technology assessment (HTA) report, which aims to evaluate the overall value of medical interventions. It has been tested and implemented in the real-world evaluation environments. After more than 10 years of development, EVIDEM framework has been updated to version 10, and the relevant operation manuals have been published. More than 40 countries have joined the collaboration and more than 20 countries have carried out relevant studies. The framework is constructed with patients, population and sustainability as the overall goals, combing the evidence and value, forming a relatively complete decision-making framework system composed of 2 levels, 7 dimensions and 20 criteria. The two levels include normative universal criteria and contextual criteria. The normative universal criteria, namely EVIDEM core model, is the quantitative evaluation, consisting of 5 dimensions and 13 criteria. Contextual criteria, namely contextual tools, are qualitative evaluation, consisting of 2 dimensions and 7 criteria. The specific operation steps of EVIDEM framework include selecting and constructing criteria, assigning weights, integrating and evaluating evidence, quantitative and qualitative evaluation of value, comprehensive value estimation and ranking based on value estimation. EVIDEM framework is applicable to disease diagnosis, treatment, management and other fields. Its application scope includes medical insurance reimbursement, clinical practice decision-making, drug selection and so on, which can provide a method for more systematic, transparent and scientific healthcare decision-making. At present, the framework has been introduced into the field of traditional Chinese medicine and can provide a scientific and feasible evaluation tool and methodology system for the clinical comprehensive evaluation of Chinese patent medicine.

6.
Article in Chinese | WPRIM | ID: wpr-940467

ABSTRACT

Traditional Chinese medicine (TCM) health technology assessment (HTA) provides scientific information and decision-making basis for decision-makers at all levels to choose TCM health technology reasonably. However, it is still in its infancy. In the future, it is necessary to strengthen top-level design, improve cognition and attention, enhance talent training and cooperation, and speed up the development of evaluation criteria in line with the characteristics of TCM, so as to promote the development of HTA in TCM. Therefore, it is imperative to create a method system and tools suitable for TCM HTA. Evidence and value impact on decisionmaking (EVIDEM) framework is developed by EVIDEM collaboration. It combines evidence and value to form a relatively complete decision-making framework system, which can provide methodological support for medical insurance reimbursement, clinical practice decision-making, drug selection and so on. The introduction of EVIDEM framework into the field of TCM has methodological feasibility and practical operability, but it is still necessary to further integrate and optimize the TCM characteristics. On the basis of theoretical research, pilot studies are carried out with Chinese patent medicine as the breakthrough point, forming a preliminary framework and implementation path for the research of TCM HTA, in order to promote healthcare decision-making and achievement transformation.

7.
Article in Chinese | WPRIM | ID: wpr-940408

ABSTRACT

This study systematically evaluated the effectiveness and safety of Dingkundan combined with conventional western medicine in the treatment of female infertility. Four Chinese databases,three English databases, and two clinical trial registration platforms were retrieved from inception to April 2021. Two researchers independently carried out literature screening,data extraction,risk assessment of bias,and grading of evidence quality. RevMan 5.4.1 was used for data analysis. A total of 216 research articles were retrieved and 21 randomized controlled trials (RCTs) were included,involving 2 172 cases. The risks of bias in the included RCTs were high. As unraveled by Meta-analysis results, Dingkundan combined with western medicine for ovulation stimulation was superior to western medicine for ovulation stimulation alone in improving pregnancy rate and progesterone level [relative risk(RR)pregnancy rate=1.67,95% confidence interval(CI)(1.44,1.93);standardized mean difference (SMD)progesterone=1.21,95% CI(0.82,1.60)]. Dingkundan combined with western medicine for improving the endometrium was superior to western medicine for improving the endometrium alone in improving the pregnancy rate [RRpregnancy rate=1.35,95% CI(1.23,1.48)]. Dingkundan combined with clomiphene was more effective than clomiphene alone in regulating endometrial thickness and reducing follicle-stimulating hormone and estradiol levels [MDendometrial thickness=3.34,95% CI(3.27,3.41), MDfollicle-stimulating hormone=-0.42,95% CI(-0.65,-0.19), MDestradiol=-4.33,95% CI (-8.18,-0.48)]. Dingkundan combined with letrozole was superior to letrozole alone in increasing the follicle-stimulating hormone level and reducing the estradiol level [MD follicle-stimulating hormone=1.14,95% CI(0.49,1.78), MDestradiol =-33.65,95% CI(-59.13,-8.17)]. The single-study results showed that Dingkundan combined with conventional western medicine had certain advantages in regulating endometrial thickness,reducing follicle-stimulating hormone,luteinizing hormone,and estradiol levels,and increasing progesterone levels. The Grading of Recommendations, Assessment, Development, and Evaluation(GRADE)system was used for the evaluation of outcome indicators. The results showed that the quality of the evidence was graded moderate or low. Based on the existing evidence,Dingkundan combined with western medicine for infertility treatment had certain advantages in increasing the pregnancy rate, improving endometrial thickness, regulating hormone levels, and reducing adverse reactions. However,affected by the quality of the included trials,the results may have limitations,and high-quality RCTs are needed for verification in the future.

8.
Journal of Integrative Medicine ; (12): 305-320, 2022.
Article in English | WPRIM | ID: wpr-939895

ABSTRACT

BACKGROUND@#Some depressed patients receive acupuncture as an adjunct to their conventional medications.@*OBJECTIVE@#This review aims to provide evidence on whether acupuncture can enhance the therapeutic effectiveness of antidepressants for treating depression, and explore whether acupuncture can reduce the adverse reactions associated with antidepressants.@*SEARCH STRATEGY@#English and Chinese databases were searched for randomized controlled trials (RCTs) published until December 1, 2021.@*INCLUSION CRITERIA@#RCTs with a modified Jadad scale score ≥ 4 were included if they compared a group of participants with depression that received acupuncture combined with antidepressants with a control group that received antidepressants alone.@*DATA EXTRACTION AND ANALYSIS@#Meta-analysis was performed, and statistical heterogeneity was assessed based on Cochran's Q statistic and its related P-value. Primary outcomes were the reduction in the severity of depression and adverse reactions associated with antidepressants, while secondary outcomes included remission rate, treatment response, social functioning, and change in antidepressant dose. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to evaluate the overall quality of evidence in the included studies.@*RESULTS@#This review included 16 studies (with a total of 1958 participants). Most studies were at high risk of performance bias and at low or unclear risk of selection bias, detection bias, attrition bias, reporting bias, and other bias. Analysis of the 16 RCTs showed that, compared with antidepressants alone, acupuncture along with antidepressants reduced the Hamilton Depression Rating Scale-17 (HAMD-17) scores (standard mean difference [SMD] -0.44, 95% confidence interval [CI] -0.55 to -0.33, P < 0.01; I2 = 14%), Self-rating Depression Scale (SDS) scores (SMD -0.53, 95% CI -0.84 to -0.23, P < 0.01; I2 = 79%), and the Side Effect Rating Scale (SERS) scores (SMD -1.11, 95% CI -1.56 to -0.66, P < 0.01; I2 = 89%). Compared with antidepressants alone, acupuncture along with antidepressants improved World Health Organization Quality of Life-BREF scores (SMD 0.31, 95% CI 0.18 to 0.44, P < 0.01; I2 = 15%), decreased the number of participants who increased their antidepressant dosages (relative risk [RR] 0.32, 95% CI 0.22 to 0.48, P < 0.01; I2 = 0%), and resulted in significantly higher remission rates (RR 1.52, 95% CI 1.26 to 1.83, P < 0.01; I2 = 0%) and treatment responses (RR 1.35, 95% CI 1.24 to 1.47, P < 0.01; I2 = 19%) in terms of HAMD-17 scores. The HAMD-17, SDS and SERS scores were assessed as low quality by GRADE and the other indices as being of moderate quality.@*CONCLUSION@#Acupuncture as an adjunct to antidepressants may enhance the therapeutic effectiveness and reduce the adverse drug reactions in patients receiving antidepressants. These findings must be interpreted with caution, as the evidence was of low or moderate quality and there was a lack of comparative data with a placebo control.@*SYSTEMATIC REVIEW REGISTRATION@#INPLASY202150008.


Subject(s)
Acupuncture Therapy/methods , Antidepressive Agents/adverse effects , Depression/drug therapy , Drug-Related Side Effects and Adverse Reactions/drug therapy , Humans
9.
Chinese Journal of Pathology ; (12): 120-125, 2022.
Article in Chinese | WPRIM | ID: wpr-935487

ABSTRACT

Objective: To investigate the clinicopathological characteristics and prognosis of high-grade B-cell lymphoma (HGBL) involving combined rearrangements of MYC, bcl-2 and bcl-6. Methods: A total of 1 138 cases of large B cell lymphoma (LBL) that were treated at the Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2017 to September 2020 were analyzed using fluorescence in situ hybridization (FISH) with probes against MYC, bcl-2 and bcl-6. The clinical and pathological data of the 45 patients with HGBL that had rearrangements of MYC and bcl-2 and/or bcl-6 were collected and retrospectively analyzed. Results: Among the 1 138 LBL, 45 (4.0%) cases had combined rearrangements of MYC, bcl-2 and/or bcl-6 that included 6 HGBL cases with MYC, bcl-2 and bcl-6 rearrangements, 14 HGBL cases with MYC and bcl-2 rearrangements, and 25 HGBL cases with MYC and bcl-6 rearrangements. Of these 45 patients, 29 patients were male, and 16 patients were female, aged 29 to 83 years. HGBL with MYC, bcl-2 and bcl-6 rearrangements and HGBL with MYC and bcl-2 rearrangement were reclassified as the germinal center B-cell (GCB) subtype using the Hans algorithm. HGBL with MYC and bcl-6 rearrangement were reclassified as the GCB subtype (68.0%) and the non-GCB subtype (32.0%). The vast majority of HGBL cases had a high Ki-67 proliferation index. Most HGBL patients had advanced stage disease with a high IPI score and an increased LDH level. Also, some patients had clinical features including elevated plasma β2-microglobulin levels, B symptoms, and bone marrow involvement. The IPI scores and LDH levels were significantly different between the HGBL cases with MYC, bcl-2 and bcl-6 rearrangements and the HGBL cases with MYC and bcl-6 rearrangements (P<0.05). Compared with the HGBL cases with MYC, bcl-2 and bcl-6 rearrangements, the HGBL cases with MYC and bcl-2 or bcl-6 rearrangements had a lower incidence of bone marrow involvement (P<0.05). There were no significant differences in the prognosis among HGBL cases with MYC, bcl-2 and bcl-6 rearrangements, the cases with MYC and bcl-2 rearrangements, and the cases with MYC and bcl-6 rearrangements (P>0.05). Conclusions: HGBL with MYC, bcl-2 and/or bcl-6 rearrangements are rare types of B-cell lymphoma with high degree of malignancy and have a short overall survival. To reduce misdiagnosis and improve diagnostic accuracy, it is necessary to assess the patients' clinical features and conduct histopathological, immunohistochemical and FISH analyses.


Subject(s)
Adult , Aged , Aged, 80 and over , China , Female , Gene Rearrangement , Humans , In Situ Hybridization, Fluorescence , Lymphoma, Large B-Cell, Diffuse/genetics , Male , Middle Aged , Prognosis , Proto-Oncogene Proteins c-bcl-2/genetics , Proto-Oncogene Proteins c-bcl-6/genetics , Proto-Oncogene Proteins c-myc/genetics , Retrospective Studies
10.
Article in Chinese | WPRIM | ID: wpr-932910

ABSTRACT

Objective:To evaluate the left ventricular diastolic dyssynchrony (LVDD) and its influencing factors early after acute myocardial infarction (AMI) using phase analysis of SPECT gated myocardial perfusion imaging (GMPI).Methods:Bama miniature swines ( n=16) were subjected to establish AMI models. GMPI was performed before and 1 d after AMI to obtain the extent of myocardial perfusion defect (Extent, %) and left ventricular systolic dyssynchrony (LVSD)/LVDD parameters, namely the phase histogram bandwidth (PBW) and phase standard deviation (PSD). Meanwhile, left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), and the ratio of early to late peak mitral diastolic flow (E/A) were obtained by echocardiography. Independent-sample t test, paired t test and Pearson correlation analysis were used to analyze the data. Results:Sixteen AMI swines were successfully created. Compared to baseline, Extent, LVEDV and LVESV significantly increased on 1 d after AMI ( t values: -11.14, -4.55, -6.12, all P<0.001), while LVEF and E/A significantly decreased ( t values: 10.16, 2.18, P<0.001, P=0.046). GMPI showed that the LVDD parameters PBW and PSD increased significantly on 1 d after AMI when compared to those at baseline((142.25±72.06)° vs (33.06±8.98)°, (56.15±26.71)° vs (12.51±5.13)°; t values: -6.11, -6.60, both P<0.001). There were significant differences between LVSD parameters and LVDD parameters (PBW: (109.06±62.40)° vs (142.25±72.06)°, PSD: (44.40±25.61)° vs (56.15±26.71)°; t values: -2.73, -2.20, P values: 0.016, 0.044). LVDD parameters PBW, PSD were negatively correlated with E/A after AMI ( r values: -0.569, -0.566, P values: 0.021, 0.022), and positively correlated with the Extent ( r values: 0.717, 0.634, P values: 0.002, 0.008). The phase analysis of SPECT GMPI to evaluate LVDD showed good intra-observer and inter-observe reproducibility (intraclass correlation coefficient (ICC): 0.953-0.984, all P<0.001). Conclusions:LVDD occurs early on 1 d after AMI, and can reflect left ventricular diastolic dysfunction. The Extent is correlated with LVDD significantly. Phase analysis of SPECT GMPI is an accurate method to evaluate LVDD and left ventricular diastolic function.

11.
Journal of Chinese Physician ; (12): 387-391, 2022.
Article in Chinese | WPRIM | ID: wpr-932075

ABSTRACT

Objective:To investigate the expression of inhibin β B (INHBB) in nasopharyngeal carcinoma (NPC) and lung adenocarcinoma (LUAD) and its relationship with clinicopathological features.Methods:Paraffin-embedded tissue specimens of 39 patients with NPC and 16 patients with chronic nasopharyngitis diagnosed by biopsy, and 30 patients with LUAD after surgical resection collected in Brain Hospital of Hunan Province (the Second People′s Hospital of Hunan Province) were analyzed retrospectively. The expression of INHBB in NPC and LUAD was detected by immunohistochemical streptavidin-perosidase (SP) method and the relationship of INHBB expression level with clinicopathological indicators was analyzed.Results:The expression of INHBB in NPC was lower than that in chronic nasopharyngitis (51.28% vs 81.25%, P=0.039), and the expression of INHBB was related to lymph node metastasis ( P=0.026) and clinical stage ( P=0.039); On the contrary, the expression level of INHBB in LUAD was significantly higher than that in adjacent tissues (86.67% vs 23.33%, P<0.001). The expression level of INHBB in patients with LUAD was only related to clinical stage ( P=0.048). Conclusions:The expression of INHBB might play an important role in the development and progression of NPC and LUAD, and it was expected to be a novel diagnostic biomarker.

12.
Chinese Critical Care Medicine ; (12): 145-150, 2022.
Article in Chinese | WPRIM | ID: wpr-931839

ABSTRACT

Objective:To study the signaling pathway of the up-regulation of claudin-5 expression by Xuebijing injection.Methods:Animal and cell models of acute respiratory distress syndrome (ARDS) were induced by lipopolysaccharide (LPS). ① In vivo study, 20 male Sprague-Dawley (SD) rats were randomly divided into 4 groups: control group, LPS group (LPS injection 10 mg/kg for 12 hours), Xuebijing control group (Xuebijing injection 1 mg/kg, twice a day, for 3 days), and Xuebijing intervention group (LPS injection after pretreatment of Xuebijing injection), according to random number method with 5 rats in each group. The lung tissues were taken to detect lung dry/wet weight ratio (W/D) and the morphological changes in each group. Claudin-5, phosphorylated forkhead box transcription factor O1 (p-FOXO1), total FOXO1 (t-FOXO1), phosphorylated Akt (p-Akt) and total Akt (t-Akt) in lung tissues were detected by immunohistochemical staining (IHC) and Western blotting. ② In vitro study, human pulmonary microvascular endothelial cells (HPMECs) were divided into 6 groups (5 holes in each group): control group, Xubijing control group (incubated with 2 g/L Xubijing for 24 hours), phosphoinositide 3-kinases (PI3K) signaling pathway LY294002 control group (incubated with 10 μmol/L LY294002 for 1 hour), LPS group (incubated with 1 mg/L LPS for 12 hours), Xubijing intervention group (incubated with 2 g/L Xuebijing for 24 hours, then with 1 mg/L LPS for 12 hours) and LY294002 intervention group (incubated with 10 μmol/L LY294002 for 1 hour, then with 2 g/L and Xubijing for 24 hours, and then with 1 mg/L LPS for 12 hours). The expression levels of claudin-5, p-FOXO1, t-FOXO1, p-Akt and t-Akt of HPMECs in each group were assessed by Western blotting. Results:In vivo study: ① Compared with the control group, the lung W/D ratio increased significantly in LPS group (6.79±0.42 vs. 4.19±0.13), and decreased significantly after the intervention of Xuebijing (4.92±0.38 vs. 6.79±0.42, P < 0.01). ② Morphological changes of lung tissue: compared with the control group, the injury of lung tissue in LPS group was more serious, which was significantly improved after Xuebijing intervention. ③ Expression levels of claudin-5, p-Akt/t-Akt and p-FOXO1/t-FOXO1: the expression levels of claudin-5, p-Akt/t-Akt and p-FOXO1/t-FOXO1 in LPS group were significantly decreased as compared with the control group (claudin-5/GAPDH: 0.33±0.03 vs. 1.03±0.07, p-Akt/t-Akt: 0.18±0.02 vs. 1.01±0.13, p-FOXO1/t-FOXO1: 0.16±0.06 vs. 1.00±0.19, all P < 0.01). After the intervention of Xuebijing, the expression levels were significantly increased as compared with the LPS group (claudin-5/GAPDH: 0.53±0.05 vs. 0.33±0.03, p-Akt/t-Akt: 0.56±0.12 vs. 0.18±0.02, p-FOXO1/t-FOXO1: 0.68±0.10 vs. 0.16±0.06, all P < 0.01). In vitro study: compared with the control group, the expression level of claudin-5 in the LPS group was significantly decreased (claudin-5/β-actin: 0.45±0.03 vs. 1.01±0.15, P < 0.01), and the expression level of claudin-5 in Xuebijing intervention group was also significantly decreased (claudin-5/β-actin: 0.80±0.08 vs. 1.01±0.15, P < 0.01). After the intervention of LY294002, the expression of claudin-5 was significantly decreased as compared with the Xubijing intervention group (claudin-5/β-actin: 0.41±0.02 vs. 0.80±0.08, P < 0.01). Conclusion:Xuebijing injection improve pulmonary vascular barrier function in rats with ARDS by up-regulating claudin-5 expression through PI3K/Akt/FOXO1 signaling pathway.

13.
Article in Chinese | WPRIM | ID: wpr-931033

ABSTRACT

Objective:To analyze the change of macular microcirculation in early diabetic patients and its correlation with visual acuity.Methods:A cross-sectional study was performed.Seventy-five eyes from 75 patients with non-diabetic retinopathy (NDR) and 33 eyes from 33 patients with non-proliferative diabetic retinopathy (NPDR) were included in Subei People's Hospital Affiliated to Yangzhou University from December 2019 to September 2020.The patients were divided into the NDR group and NPDR group according to their condition.Another 35 eyes from 35 healthy subjects served as the control group.Optical coherence tomography angiography (OCTA) images were acquired over 3 mm×3 mm regions centered on the fovea using RTVue XR OCTA device and the data were quantified with Angio Vue software.The area, perimeter and acircularity index (AI) of the macular foveal avascular zone (FAZ), the grading of abnormal superficial and deep FAZ contour, as well as the vessel density of superficial capillary plexuses (SCP), deep capillary plexuses (DCP) and a 300 μm ring area beside FAZ (FD300) were analyzed and compared among the three groups.The correlations between these indexes and visual acuity were analyzed.This study protocol adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Subei People's Hospital affiliated to Yangzhou University (No.2018KY-167). Written informed consent was obtained from each subject prior to any medical examination.Results:No statistically significant differences were found in the FAZ area, FAZ perimeter and AI among the three groups ( F=1.948, P=0.146; F=2.632, P=0.075; H=5.582, P=0.061). The proportions of superficial and deep FAZ contour abnormality were 54.5%(18/33) and 87.9%(29/33) in the NPDR group, 37.3%(28/75) and 70.7%(53/75) in the NDR group, 22.9%(8/35) and 42.9%(15/35) in the control group, respectively, the proportions of superficial and deep FAZ contour abnormality in the NPDR group were significantly higher than those in the control group (both at P<0.05). With the aggravation of the condition, there were more eyes with high grades of abnormal superficial and deep FAZ contours ( χ2=9.827, 9.030; all at P<0.05). The vessel density of parafoveal DCP was (52.50[50.70, 54.80]), (50.40[48.40, 52.60]), (48.30[43.60, 51.55])%, and the vessel density of DCP was (49.90[47.70, 51.80]), (47.30[45.20, 50.10]), (45.80[41.30, 48.60])% in the control group, NDR group and NPDR group respectively, and there were statistically significant differences among the three groups ( H=21.719, 21.652; both at P<0.001), and statistically significant differences were found in pairwise comparisons among the three groups (all at P<0.05). The vessel densities of foveal SCP, foveal DCP and FD300 in the NPDR group were significantly lower than those in the control group (all at P<0.05). There was no statistically significant difference in vessel densities of parafoveal SCP and SCP found in the overall comparison among the three groups ( H=5.290, 5.534; both at P>0.05). In diabetic mellitus patients, there were negative correlations between the vessel density of parafoveal SCP and LogMAR best corrected visual acuity (BCVA), and between the vessel density of SCP and LogMAR BCVA ( rs=-0.305, -0.330; both at P<0.05), and there was a positive correlation between the superficial FAZ contour grading and LogMAR BCVA ( rs=0.353, P<0.05). Conclusions:Abnormal parafoveal DCP and DCP vessel density, as well as FAZ contour, appear in diabetic mellitus patients before the occurrence of visible fundus lesion, and the vessel density of parafoveal SCP and SCP, and superficial FAZ contour grading in diabetic mellitus patients are correlated with visual acuity.OCTA can help monitor disease progression and identify microcirculation parameters that affect visual function.

14.
Article in Chinese | WPRIM | ID: wpr-930516

ABSTRACT

Clinical data of a child with congenital myopathy caused by the SPEG gene mutation diagnosed in the Children′s Hospital of Nanjing Medical University in March 2020 were retrospectively analyzed, and the relevant literature was reviewed.A 13-year-old female child with lagged motor development since childhood, weakness of both lower extremities for 10 years, and slow progression of disease.Physical examinations showed gait swinging, mild hypertrophy of gastrocnemius, positive Gower sign, grade Ⅴ distal muscle strength of both lower extremities, and grade Ⅳ proximal muscle strength.The electromyography showed myogenic damage changes.Her 11-year-old sister presented similar symptoms of muscle weakness.Gene sequencing revealed compound heterozygous mutations in the SPEG gene, with the newly reported mutation sites at c. 3715+ 4C>T and c. 3588delC, which had not been reported at home and abroad.This study for the first time reported a case of congenital myopathy caused by the SPEG gene mutation in China, which differed from previous cases accompanied cardiomyopathy.This case report expanded the mutation spectrum of the SPEG gene.

15.
Article in English | WPRIM | ID: wpr-922536

ABSTRACT

BACKGROUND@#Functional constipation (FC) is one of the most prevalent functional gastrointestinal disorders. Dissatisfaction with medications prescribed to treat FC may lead patients to seek alternative treatments. Numerous systematic reviews (SRs) examining the use of acupuncture to treat FC have reported inconsistent results, and the quality of these studies has not been fully evaluated.@*OBJECTIVE@#In this overview, we evaluated and summarized clinical evidence on the effectiveness and safety of acupuncture for treating FC and evaluated the quality and bias of the SRs we reviewed.@*SEARCH STRATEGY@#The search strategy was structured by medical subject headings and search terms such as "acupuncture therapy" and "functional constipation." Electronic searches were conducted in eight databases from their inception to September 2020.@*INCLUSION CRITERIA@#SRs that investigated the effectiveness and safety of acupuncture for managing FC were included.@*DATA EXTRACTION AND ANALYSIS@#Two authors independently extracted information and appraised the methodology, reporting accuracy, quality of evidence, and risk of bias using the following critical appraisal tools: (1) A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2); (2) Risk of Bias in Systematic Reviews (ROBIS); (3) Preferred Reporting Items for Systematic Reviews and Meta-analyses for Acupuncture (PRISMA-A); and (4) the Grading of Recommendations, Assessment, Development and Evaluations (GRADE). A κ index was used to score the level of agreement between the 2 reviewers.@*RESULTS@#Thirteen SRs that examined the clinical utility of acupuncture for treating FC were identified. Using the AMSTAR 2 tool, we rated 92.3% (12/13) of the SRs as "critically low" confidence and one study as "low" confidence. Using the ROBIS criteria, 38.5% (5/13) of the SRs were considered to have "low risk" of bias. Based on PRISMA-A, 76.9% (10/13) of the SRs had over 70% compliance with reporting standards. The inter-rater agreement was good for AMSTAR 2, ROBIS, and PRISMA-A. Using the GRADE tool, we classified 22.5% (9/40) of the measured outcomes as "moderate" quality, 57.5% (23/40) as "low" quality, and 20.0% (8/40) as "very low" quality. The inter-rater agreement was moderate when using GRADE. Descriptive analyses indicated that acupuncture was more efficacious than sham acupuncture for improving weekly complete spontaneous bowel movements (CSBMs) and for raising the Bristol Stool Form Scale (BSFS) score. Acupuncture appeared to be superior to anti-constipation drugs for improving weekly spontaneous bowel movements, the total effective rate, and the Patient Assessment of Constipation Quality of Life score. Although ten SRs mentioned the occurrence of adverse events, serious adverse events were not associated with acupuncture treatment.@*CONCLUSION@#Acupuncture may be more efficacious than sham acupuncture for improving CSBMs and BSFS scores and may be superior to anti-constipation drugs for improving bowel movement frequency, as well as quality of life. Limitations to current studies and inconsistent evidence suggest a need for more rigorous and methodologically sound SRs to draw definitive conclusions.@*SYSTEMATIC REVIEW REGISTRATION@#PROSPERO CRD42020189173.


Subject(s)
Acupuncture Therapy , Constipation/therapy , Humans , Quality of Life , Systematic Reviews as Topic
16.
Article in English | WPRIM | ID: wpr-928584

ABSTRACT

OBJECTIVES@#To study the changes in the distribution and drug resistance profiles of pathogens causing bloodstream infection after chemotherapy in children with acute lymphoblastic leukemia.@*METHODS@#The medical data were collected from the children with acute lymphoblastic leukemia who were admitted to the First Affiliated Hospital of Zhengzhou University between January 2015 and December 2020 and developed bloodstream infection after chemotherapy. The samples were divided into the first three years group and the next three years group according to the time of testing to investigate the differences in the distribution and drug resistance profiles of pathogens as time.@*RESULTS@#A total of 235 strains of pathogens were isolated, among which there were 159 Gram-negative strains (67.7%; mainly Escherichia coli and Klebsiella pneumoniae), 61 Gram-positive strains (26.0%; mainly Staphylococcus epidermidis), and 15 strains of fungi (6.4%; mainly Candida albicans). There were no significant differences between the first three years group and the next three years group in the detection rate of Gram-negative bacteria (68.8% vs 66.9%, P>0.05) or Gram-positive bacteria (29.2% vs 23.7%, P>0.05). Compared with the first three years group, the next three years group had significant increases in the detection rate of Streptococcus mitis (5.8% vs 0.0%, P<0.05) and fungi (9.4% vs 2.1%, P<0.05). There was no significant difference in the drug resistance rate of Gram-negative or Gram-positive bacteria between the two groups (P>0.05).@*CONCLUSIONS@#Enterobacteriaceae bacteria are the main pathogens of bloodstream infection after chemotherapy in children with acute lymphoblastic leukemia, while the detection rates of Streptococcus mitis and fungi tend to increase as time, which needs to be taken seriously in clinical practice.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Bacteremia/drug therapy , Child , Drug Resistance, Bacterial , Gram-Negative Bacteria , Humans , Methicillin-Resistant Staphylococcus aureus , Microbial Sensitivity Tests , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Retrospective Studies , Sepsis/drug therapy
17.
Article in English | WPRIM | ID: wpr-927627

ABSTRACT

OBJECTIVE@#The association between neutrophil-to-lymphocyte ratio (NLR) with subclinical macrovascular and microvascular diseases has been less investigated. We sought to examine the association between NLR and new-onset subclinical macrovascular and microvascular abnormalities in the Chinese population.@*METHODS@#From a community cohort, we included 6,430 adults aged ≥ 40 years without subclinical macrovascular and microvascular diseases at baseline. We measured subclinical macrovascular and microvascular abnormalities separately using the ankle-brachial index (ABI), brachial-ankle pulse wave velocity (baPWV), and albuminuria.@*RESULTS@#During a mean follow-up of 4.3 years, 110 participants developed incident abnormal ABI, 746 participants developed incident elevated baPWV, and 503 participants developed incident albuminuria. Poisson regression analysis indicated that NLR was significantly associated with an increased risk of new-onset abnormal ABI, elevated baPWV, and albuminuria. Compared to overweight/obese participants, we found a much stronger association between NLR and subclinical vascular abnormalities in participants with normal weight. Furthermore, we found an interaction between the NLR and body mass index (BMI) on the risk of new-onset abnormal ABI ( P for interaction: 0.01).@*CONCLUSION@#NLR was associated with subclinical macrovascular and microvascular diseases in the Chinese population. Furthermore, in participants with normal weight, the association between NLR and subclinical vascular abnormalities was much stronger.


Subject(s)
Adult , Aged , Ankle Brachial Index , Body Mass Index , China/epidemiology , Cohort Studies , Female , Humans , Incidence , Lymphocytes/cytology , Male , Middle Aged , Neutrophils/cytology , Poisson Distribution , Prospective Studies , Vascular Diseases/etiology
18.
Article in Chinese | WPRIM | ID: wpr-885316

ABSTRACT

Objective:To explore the clinicalfactors related to allograft fibrosis after pediatric liver transplantation.Methods:The clinical data were respectively analyzed for 94 pediatric recipients from January 2013 to December 2016 at Tianjin First Central Hospital.The Patients were assigned into fibrotic and non-fibrotic groups based upon the results of protocol liver biopsies. Univariate and multivariate Logistic regression analyses were performed for examining the risk factors of fibrosis after pediatric livertransplantation. Then Logistic regression model was established to obtain the predicted value of combined predictive factors.Thereceiver operating characteristic curve (ROC) was conducted to evaluate the predictive value of combined predictive factors.Results:A total number of 54(57.5%) patients occurred fibrosis among the 94 patients. There weresignificant differences in cold ischemia time (Z=2.094), warm ischemia time (Z=2.421), biliary stricture( χ2=4.560), drug-induced liver injury ( χ2=7.389), hepatic artery thrombosis and rejection ( χ2=6.955)between two groups ( P<0.05). Logistic regression analysis showed that cold ischemia time (OR=1.003, 95%CI: 1.000~1.007, P=0.044), biliary stricture(OR=6.451, 95%CI: 1.205~33.295), rejection(OR=2.735, 95%CI: 1.057~7.077)and drug-induced liver injury (OR=4.977, 95%CI: 1.207~20.522, P=0.026) were independent risk factors for fibrosis 5 years after liver transplantation. The area under the ROC curve was 0.786(95%CI: 0.691~0.881), for predicting patient outcome.If using 0.311as a cutoff Value, the sensitivity was 90.70%, and the specificity was 60.00%. However, through the ROC curve comparison, there was statistical significance between combined predictive factors and the other independent risk factors ( P>0.05). Conclusions:The incidence of fibrosis 5 years after pediatricliver transplantation is 57.5%. Prolonged cold ischemia time, biliarystricture, rejectionand drug-induced liver injury after liver transplantation are independent risk factors for fibrosis 5 years after pediatric liver transplantation.And the combined predictive factors have a high predictive value forallograftfibrosis.

19.
Article in Chinese | WPRIM | ID: wpr-912880

ABSTRACT

Objective: To observe the effects of acupuncture at the Governor Vessel acupoints plus language training on the language function and cerebral blood flow in patients with motor aphasia after ischemic stroke. Methods: Eighty-six patients were randomized into a control group and an observation group, with 43 cases in each group. Conventional symptomatic treatment was offered to both groups. Besides, the control group received language training, while the observation group received language training plus additional acupuncture at the Governor Vessel acupoints. Before and after treatment, the aphasia battery of Chinese (ABC) and Chinese functional communication profile (CFCP) were tested, and the mean velocity (Vm) and resistance index (RI) of the left middle cerebral artery (MCA) were detected. Results: The total effective rate was higher in the observation group than in the control group (P<0.05). After treatment, the observation group gained higher scores in oral expression, comprehension, repeating, naming objects, reading, and writing, as well as the general score of ABC (all P<0.05), higher than those in the control group (all P<0.05). The CFCP score increased in both groups after intervention, showing significant intra-group differences (both P<0.05), and the CFCP score was higher in the observation group than in the control group (P<0.05). After treatment, Vm of the left side MCA increased in the control group (P<0.05), while no significant change was observed in RI (P>0.05); in the observation group, Vm of the left side MCA increased and RI decreased significantly compared with the baseline (both P<0.05), and were markedly different from those in the control group (both P<0.05). Conclusion: Acupuncture at the Governor Vessel acupoints plus language training can produce valid efficacy in treating motor aphasia after ischemic stroke; it can notably improve the language function, everyday oral communication ability, and increase cerebral perfusion of the patients.

20.
Article in Chinese | WPRIM | ID: wpr-912838

ABSTRACT

Cloud technology and the Internet of things ( IOT) technology can be used in building the patient-centered critical care medical information platform.The platform could inenable medical staff to efficiently obtain critical care medical information, and raise critical patients′ cure rates. The authors introduced the critical process of rapidly building and improving the urgent care medical information integration platform in a campus of the First Affiliated Hospital of Zhejiang University Medical School.The IOT platform could effectively interconnect a variety of critical care medical equipments, and features such functions as vital signs monitoring and life support, bedside treatment data retrieval, remote diagnosis and treatment, and cloud sharing. The platform featured the advantages of complete information integration, fast construction, and satisfactory system extensibility. It could improve the medical work efficiency, improve the effect of critical care, and reduce the frequency of contact with patients, hence providing references for rapidly establishing a vital care treatment platform for public health events.

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